The specific features of the diagnosis and treatment of coronary heart disease in rheumatoid arthritis (Results of the authors’ studies)

Coronary heart disease (CHD) and its complications occupy the leading place in the pattern of the causes of untimely death in rheumatoid arthritis (RA). Objective: to study the incidence, pattern, and specific features of CHD in patients with RA. Patients and methods. An analytical cross-sectional study was conducted in 257 patients with RA (ARA, 1987). The patients’ mean age was 55.4±11.6 years; RA duration was 14.7years (range 2—20 years). Results. The incidence of CHD in RA was as much as 45.9% (n = 118), including 52.5% (n = 62) for typical angina pectoris on exertion; 25.4% (n = 30) and 22.1% (n = 26) for silent ischemia and arrhythmias, respectively. A high proportion of vertebrogenic cardialgias (48.8%; n = 100) were noted in those who complained of heart pain. The authors identified traditional risk factors, such as hypertension (OR = 12.1), smoking (OR = 10.2), early menopause (OR = 3.6), decreased glomerular filtration rate (OR = 3.5), cardiovascular heredity (OR = 3.1), overweight (OR = 2.5), a heart rate of more than 70 beats/min (OR = 2.3), atherogenic dyslipidemia (OR = 2.3), hyperglycemia (OR = 2.1), and age (OR = 1.7). Along with those, the authors also ascertained CHD predictors associating with chronic inflammation consequences: use of glucocorticoids (OR = 5.0), concomitant anemia as a common complication of RA (OR = 4.7), high DAS 28 scores (OR = 3.7), visual analog scale pain scores of > 50 mm (OR = 2.6), and RA duration of >10 years (OR = 2.2). Conclusion. The specific features of CHD in RA include the frequent detection of arrhythmias and silent ischemia. The importance of the degree of inflammatory activity along with the traditional risk factors of CHD is apparent

Особенности диагностики и лечения ишемической болезни сердца при ревматоидном артрите (результаты собственных исследований)

Coronary heart disease (CHD) and its complications occupy the leading place in the pattern of the causes of untimely death in rheumatoid arthritis (RA). Objective: to study the incidence, pattern, and specific features of CHD in patients with RA. Patients and methods. An analytical cross-sectional study was conducted in 257 patients with RA (ARA, 1987). The patients’ mean age was 55.4±11.6 years; RA duration was 14.7years (range 2—20 years). Results. The incidence of CHD in RA was as much as 45.9% (n = 118), including 52.5% (n = 62) for typical angina pectoris on exertion; 25.4% (n = 30) and 22.1% (n = 26) for silent ischemia and arrhythmias, respectively. A high proportion of vertebrogenic cardialgias (48.8%; n = 100) were noted in those who complained of heart pain. The authors identified traditional risk factors, such as hypertension (OR = 12.1), smoking (OR = 10.2), early menopause (OR = 3.6), decreased glomerular filtration rate (OR = 3.5), cardiovascular heredity (OR = 3.1), overweight (OR = 2.5), a heart rate of more than 70 beats/min (OR = 2.3), atherogenic dyslipidemia (OR = 2.3), hyperglycemia (OR = 2.1), and age (OR = 1.7). Along with those, the authors also ascertained CHD predictors associating with chronic inflammation consequences: use of glucocorticoids (OR = 5.0), concomitant anemia as a common complication of RA (OR = 4.7), high DAS 28 scores (OR = 3.7), visual analog scale pain scores of > 50 mm (OR = 2.6), and RA duration of >10 years (OR = 2.2). Conclusion. The specific features of CHD in RA include the frequent detection of arrhythmias and silent ischemia. The importance of the degree of inflammatory activity along with the traditional risk factors of CHD is apparent.В структуре причин преждевременной смертности при ревматоидном артрите (РА) ведущее место занимают ишемическая болезнь сердца (ИБС) и ее осложнения. Цель исследования — изучение частоты, структуры и особенностей течения ИБС у больных РА. Пациенты и методы. Проведено аналитическое одномоментное поперечное исследование 257 пациентов с РА (ARA, 1987). Средний возраст больных составил 55,4+11,6 года, продолжительность РА — 14,7(2; 20) года. Результаты исследования. Частота ИБС при РА достигала 45,9% (n=118), в том числе типичной стенокардии напряжения — 52,5% (n=62), безболевой ишемии и нарушений ритма — 25,4% (n=30) и 22,1% (n=26) соответственно. Отмечен высокий удельный вес вертеброгенных кардиалгий (48,8%; n=100) у предъявлявших жалобы на боли в области сердца. Выявлены традиционные факторы риска, такие как артериальная гипертензия (ОР — 12,1), курение (ОР — 10,2), ранняя менопауза (ОР — 3,6), снижение скорости клубочковой фильтрации (ОР — 3,5), наследственность по сердечно-сосудистым заболеваниям (ОР — 3,1), избыточная масса тела (ОР — 2,5), частота сердечных сокращений — более 70 уд/мин (ОР — 2,3), атерогенные дислипидемии (ОР — 2,3), гипергликемия (ОР — 2,1) и возраст (ОР — 1,7). Наряду с ними установлены предикторы ИБС, ассоциирующиеся с последствиями хронического воспаления — прием глюкокортикоидов (ОР — 5,0), сопутствующая анемия как частое осложнение РА (ОР — 4,7), высокая активность РА по DAS 28 (ОР — 3,7), ВАШ боли >50 мм (ОР — 2,6) и давность >10 лет (ОР — 2,2). Выводы. К особенностям течения ИБС при РА относится частое выявление нарушений ритма и безболевой ишемии. Наряду с традиционными факторами риска ИБС очевидно значение степени активности воспаления

Clinical-Epidemiological Peculiarities of the Tick-Borne Borrelioses Registered in the Trans-Baikal Territory

Complex analysis of the data on epidemiology and clinical picture of the tick-borne borrelioses in the territory of the Trans-Baikal Region over the last decade since 2003 to 2012 has demonstrated that there is a distinct upward tendency as concerns its morbidity rates. Spotted have been the potentially hazardous, as regards the infection, areas. Highest incidence rates are registered between May-July among adult men, and erythema form of the disease prevails. Based on the results of molecular-genetic investigation of Ixodidae ticks, for the first time ever in the territory of the Dul’durginsk Region identified has been circulation of Borrelia garinii , and B. afzelii , pathogenic for humans bacterial species of Borrelia genus

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

Experience of using sibutramine in combination with microcrystalline cellulose in clinical practice

For many years, interest in the issue of obesity has not faded, as obesity is now one of the most common pathologies in the world that directly affects quality of life and lifespan. Even a slight weight loss (5-10% of baseline values) in obese patients is known to improve metabolism and reduce the risk of a range of comorbidities. The article reflects the importance of comprehensive treatment of obesity, presents positive experience of using Reduxin (sibutramine in combination with microcrystalline cellulose) to reduce body weight and risk factors for cardiovascular disease in a specific clinical example in a patient with exogenous-constitutional obesity and eating disorders. The case of obesity in a young man of 24 years old is presented, when other components of the metabolic syndrome (except for arterial hypertension) were not formed. Thus, following the results of 24-week complex treatment, clinically significant reduction of body weight (by 21.7% of initial values) was observed in the patient. The data of psychological researches have shown that the patient has no increase of anxiety and depression level during treatment, but at the same time the indicators of quality of life according to the results of health questionnaire testing have improved. This clinical case corresponds to the results of the PrimaVera program and demonstrates that weight loss during sibutramine therapy in combination with microcrystalline cellulose has a positive impact on the overall health and emotional status of patients and leads to improved quality of life. Therefore, successful treatment of obesity and the maintenance of other outcomes are key to preventing cardiovascular disease

Characteristics of the circadian profile of heart rate during genetically determined hypertension

Prevalence and importance of hypertension in the general incidence structure determines a wide range of research problems. Chronobiological indices are of great importance in the investigatory activity concerning mechanisms of essential hypertension. Our work was focused on the dynamics of HR circadian profile at different terms in male SHR rats with the use of telemetry monitoring. The obtained data showed considerable changes of cardiac rhythm in different time intervals which was understood as inhibition of the chronotropic function of the heart

Sitagliptin: the world’s first DPP-4 inhibitor

The prevalence of T2D is steadily increasing annually, which resulted in an active search for a way to control the disease. The last decade has seen a rise in the number of new groups of glucose-lowering drugs, which not only proved effective in the management of hyperglycemia and safe against hypoglycemia, but also joined the ranks of the drugs of the first-line therapy. Among them is incretin-active agents - type 4 dipeptidyl peptidases inhibitors (IDPP-4, glyptines). Sitagliptin was the world's first approved IDPP-4, and began to be used successfully in Russia since 2007. The review presents data on the efficacy, safety (including cardiac safety) of sitagliptin use and accumulated experience of its use in the treatment of patients with type 2 diabetes

Human herpesviruses in the pathogenesis of orbit and eye tumors: detection of herpesvirus DNA in tumor biopsies

Biopsy samples of 32 patients with uveal melanoma (10), RBL (11), orbital lymphoma (7), lacrimal gland adenomas (2), rhabdomyosarcoma of conjunctiva (2) were tested by real time polymerase chain reaction (PCR) to detect the DNA of HSV 1, HSV 2, EBV, CMV, HHV-6, HHV-8, Toxoplasma gondii, Mycoplasma hominis, Ureaplasma spp. Totally, 14 of 32 (43.75 %) tumor samples revealed DNA herpesviruses, Chlamydia trachomatis, mycoplasma hominis or ureaplasma spp. Positive PCR results were revealed in orbital lymphoma almost 2 times more frequently than in RBL (6/7 - 85.7 % and 5/11 - 45.5 %; p = 0.15), and 4 times more frequently than in uveal melanoma (6/7 - 85.7 % and 2/10 - 20%; р = 0.015). The spectrum of pathogens in different tumors varied. Only genomes of lymphotropic HHV (EBV, HHV-6, HHV-8) with predominance of EBV are found in orbital lymphoma. In RBL, we could identify DNA of HHV 6, EBV, CMV, and ureaplasma. Infectious DNA were detected the least frequently (2 out of 10 patients) in biopsies of uveal melanoma: in both cases, Chlamydia trachomatis genome was found, in one of them it combined with EBV and CMV DNA. Plasma investigation revealed positive PCR results significantly less frequently than in biopsies (1/28 and 14/32; p = 0.002). Further studies are needed to assess the role of persistent pathogens, primarily human herpesviruses, Chlamydia and ureaplasma in the pathogenesis of orbit and eye tumors // Russian Ophthalmological Journal, 2016; 2: 42-46 . doi: 10.21516/2072-0076-2016-9-2-42-46

The Effectiveness of Laboratory Methods for the Early Differential Diagnosis of Ophthalmohlamidiosis and Conjunctival Lymphoma (Clinical Cases)

Conjunctival lymphomas are predominantly extranodal B-cell non-Hodgkin’s lymphomas (NHL), most of them are MALT-lymphomas originating from the mucosa-associated lymphoid tissue. Manifestations of the conjunctival NHL are very diverse, and often imitate the appearance of other ocular diseases, which makes their clinical diagnosis difficult and significantly lengthens the time from the first visit to the ophthalmologist until the diagnosis is verified. The article presents the case histories of two young patients who were treated for a long time at the place of residence as acute chlamydial conjunctivitis (in one case — 3, in the other — almost 5 months). A comprehensive laboratory study to detect specific blood antibodies, DNA of the pathogen in conjunctival scrapings and the cytological picture of the conjunctiva did not confirm the chlamydial etiology of the process. A pronounced lymphoid reaction mainly due to small lymphoid cells was found in both patients in scrapings from the conjunctiva of the eyelid, which was the basis for referring patients for consultation to oncologist. Histological examination of conjunctival biopsy specimens also revealed proliferation of lymphoid tissue: patients with suspected MALT lymphoma were referred to onco-hematologists. A PCR analysis of the biopsy material revealed HHV-8 DNA in one patient and Epstein-Barr (EBV) DNA in another, although no pathogen genomes were detected in the conjunctiva scrapings. Immunohistochemical analysis in one patient confirmed the conjunctival MALT-lymphoma, in another one diagnosed hyperplasia of the conjunctival mucous-associated lymphoid tissue, caused by prolonged antigenic stimulation (EBV DNA was detected in the biopsy). The follicular appearance of the lymphocyte hyperplasia in conjunctiva may imitate the clinical picture of infectious diseases. For differential diagnosis of chlamydial conjunctivitis and MALTlymphoma, especially in young patients with refractory follicular conjunctivitis, it is advisable to include a set of serological, molecular biology and cytological methods